Document Detail


The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions.
MedLine Citation:
PMID:  2064489     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.
Authors:
C Cimino; R B Lipton; A Williams; E Feraru; C Harris; A Hirschfeld
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  151     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1991 Jul 
Date Detail:
Created Date:  1991-08-08     Completed Date:  1991-08-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1381-4     Citation Subset:  AIM; IM; X    
Affiliation:
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
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MeSH Terms
Descriptor/Qualifier:
Bayes Theorem
Biopsy, Needle / adverse effects
Brain Diseases / complications*,  pathology,  radiography
Follow-Up Studies
HIV Infections / complications*
Humans
Predictive Value of Tests
Sensitivity and Specificity
Tomography, X-Ray Computed
Toxoplasmosis / complications*,  drug therapy,  pathology,  radiography
Comments/Corrections
Comment In:
Arch Intern Med. 1992 Oct;152(10):2139-40   [PMID:  1417389 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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